This morning the airwaves are awash with a story about a new report Damian Green MP has authored for a right-leaning think tank on how to fix the social care crisis (their description).
What's the story?
The broadcasters say the report recommends a new scheme for paying for care that’s “like the State Pension”, with a basic level of provision that would accord an older person a decent level of service plus an opportunity to ‘top up’ for extras like better food or a bigger room in a care home. Mr Green proposes a form of insurance for people to opt into for this higher level of provision, should they wish to and be able to afford it.
Highlighting the problem
It would be interesting to know what Mr Green’s former colleagues in Government are making of his intervention. Some will no doubt be jealous of his ability to write about what he thinks without a tortuous process of cross departmental clearance and, above all, the near impossibility of getting the Treasury to agree to anything with a substantial price tag attached. I suspect others though will be irritated that he is drawing attention to a problem for which, so far, they have demonstrably failed to come up with any solutions – as the wait for the Green Paper goes on and on.
What’s the purpose of the report?
From that point of view the report may be seen as something of a rebuke; as First Secretary of State Mr Green kicked off the Green Paper two years ago now but lost responsibility for it, of course, when he left the Government. The obvious question that arises is if a single MP backed by a think tank can produce a serious report with some costed proposals, why can’t Her Majesty’s Government with all the enormous resources at its disposal do the same? From that perspective it could be argued that the very fact of him producing this report makes it harder for the Government to drop it altogether, were they minded to do so – in which case good!
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Doing a great service
In two important respects I think Damian Green does his colleagues in Government a great service. Firstly, he shows that it is possible to say something quite complicated about reforming the funding of care in a way that ‘cuts through’ in the media. In communication terms the idea of saying that in future care funding should be ‘like the State Pension’ is very smart in my view: people know – or think they know – what the State Pension is and it is also an absolutely fundamental part of the infrastructure of any modern State. Public ignorance about how social care works and is funded, even what it is, has long been a barrier to politicians reforming it; Damian Green has side-stepped that problem, at least as far as a soundbite is concerned. And face it, in our current media culture this matters more than ever.
Secondly, Damian Green shows that it is possible to be a Conservative and still have something to say about care funding which takes the debate forward. It would be hard to exaggerate how terrified many people on the Right are of ‘another dementia tax debacle’, following the one that they essentially brought upon themselves through the controversial Conservative manifesto at the last Election. This fear acts as an inhibitor in terms of the production of new ideas and is surely one reason why the Green Paper has been so long delayed.
The verdict on the report
But is the substance of the report any good? I have only skim read it so far so I will not proffer a firm opinion on it yet, but even at this stage I have to say I agree with Simon Bottery at the King’s Fund who has been tweeting about it this morning: I think it looks seriously over-optimistic about costs and therefore underplays the challenge of how much money needs to be raised from the public to achieve the necessary transformation.
Secondly, the report floats an opt-in or auto-enrolment type of approach to insurance in order for people to ‘top up’ their provision. The problems with this idea are various; if of an auto-enrolment type it could inadvertently undermine pension saving, which would be very bad news for younger generations. In addition, the chances are that many would opt out of a voluntary scheme if they could, preferring to take their chances later on. This means the risk of developing a social care need would not be universally pooled, which seems to me to be a basic requirement of whatever new scheme we get for funding care. The reason is that only if we all contribute – a modest amount – will we be able to generate enough money overall so that everyone can be sure of having their care needs met. Such a scheme would therefore have to be compulsory.
And finally, there is a big risk that although this ‘topping up’ is premised as being to give people better care rather than good enough care, it could in fact end up being necessary for even acceptable provision – which is essentially how the ‘top ups’ regime operates now. Many families find they have to pay substantial amounts extra, even when their loved one’s care is theoretically the responsibility of the State to fund, in order to secure an acceptable care home place in their local area rather than miles away.
Not going ‘the whole hog’
So Mr Green goes some way towards recommending the universal pooled approach that I am sure we need, but not all the way. As a Conservative Mr Green may feel that ‘the whole hog’ constitutes too big an expansion of the role of the State to be conscionable ideologically. It is believed that this idea of universal, State backed risk pooling is also opposed by the Treasury, which more generally seems to be in denial about the consequences of an ageing population for the funding of public services – another probable reason why the Green Paper has been held up for month after month. The problem is though that nothing less than universal risk pooling is likely to do. It is what they have done with some success in Japan and Germany - perhaps this is why Mr Green says clearly in his report that he does not think any other country has a model that is a blueprint for us here.
Mr Green is a wily and experienced politician and his report about the future of social care is one in which navigating the politics, especially from a Conservative perspective, is a – perhaps the - key concern. This explains, I believe, why the report does not attempt to address the needs of disabled and chronically unwell people for whom a good care system is every bit important as it is for older people. My guess is that Mr Green is fully aware of this fact but that in his report he is sending some important signals to decision makers. He is both challenging the Government to move forward on care funding reform and perhaps giving them some clues as to how they might do so ‘safely’ from their political point of view.
It may be that the report also deliberately blows a raspberry at ‘The Treasury View’, since it is upfront about the imperative of reforming the funding of care, the parlous state of the care system at the moment, and the fact that sorting it out will cost significant amounts of public funds – albeit only modest sums when compared to public spending overall, as Andrew Dilnot always points out.